MC-19-199Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: MC-01-19-199
�j Permit Type: Mechanical - Residential
rrccJI Work Classification: Addition/Alteration
�
Permit Status: Approved
Issue Date: 01/30/2019 1 Expiration: 07/29/2019
Location Address Parcel Number
940 NE 99 ST, Miami Shores, FL 33138 1132060143380
Contacts
VICTOR MAYORGA Owner VICTOR MAYORGA Applicant
940 NE 99 ST, MIAMI SHORES, FL 33138 940 NE 99 ST, MIAMI SHORES, FL 33138
CLIMATE CONTROL, INC Contractor
LIONEL CASTILLO
14010 SW 130 PL, MIAMI, FL 33186
Business: 3055254501
Description: INSTALL 1 SUPPLY IN ADDITION Valuation: $ 350.00 Inspection Requests:
305-762-4949
Total Sq Feet: 240.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$110.30
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$110.30
Credit Card
01/28/2019 $50.00
Credit Card
01/30/2019 $60.30
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor
/ Agent
Date
January 30, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
Miami Shores Village RECEIVED
Building Department JAN28 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 (� f
Tel: (305) 795-2204 Fax: (305) 756-8972 ✓I
INSPECTION LINE PHONE NUMBER: (305) 762-4949 Q `
FBC 209
Master Permit No. (�C 1,6 11?411
Sub Permit No. C IQ 't Cl Q
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
Q y O wn: sdrec'f
City: Miami Shores County: Miami Dade Zip: 3313 l(
Folio/Parcel#: AA- 3 L06 - O 1 y - 3 3'90 Is the Building Historically Designated: Yes NO X
Occupancy Type: 5F VL Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Vj=vL A • MA1yoAAA Phone#: 1(%0)01414- 23ZA1
Address: CIg0 0%; 99TL STrcz, _
City: AlAN1t, Qom State: Zip: 331 3 Fi
Tenant/Lessee Name: NiAe Phone#: N/p'
Email: ViC.TO(L - MAY0&(�A '}} 0- 6hkK%L-. c&Vx
CONTRACTOR: Company Name: C/ /x4AT'(�' C.O/JY20L -T'A%C_ Phone#: St?S- "7'r Ol
Address: /a -'S co 1.3 O Pzi9ce
City: State: Zip:
Zip: •3� /
Qualifier Name: L foN CE L Ili CA-s_Tl e-L-6 Phone#:,�Gtf� S3S" �1S"o1
State Certification or Registration #: C/9 C 033 6 D -7 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ �� .S—G. 0"' Square/Linear Footage of Work:
Type of Work: 'Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: -7;0 4-?r 1 L L 4 S L fPL_ -YU �,4-bat %00
!� ".jr v v - r 4 , iqA1+)4 ; AAH'43r2 .,...,
r: t'' {'� t of �..1U9 MRt•'N ylJ �i
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $t.
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $.
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
HE
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will'be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspec 'o fee will be charged.
Signature _ Signature`'
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
_ day of Jam� 12019 by
ViCIVAL A - MAYWL C��' , who is personally now
T f or w o has produced as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
tw
_ day of �n 20 (— I by
C 4vF�iO� s pers on known to
V1
me or who has produced t— I Iwn,—�Z as
identification and who did take an oath.
NOTARY
Sign:
Print: S Print: MAHARAIK.GONZALEZ
••;:nj.!ue �•
N�� Seal: *' o EXPIRES: November 2, 2020
Seal: 'mow Seal: POMARES : - yr1 O:` BondedThruNotaryPublicUnderwriters
Notary Public . State of Florida Vic„
Commission N FF 997687
My Comm. Expires Sep 26, 2020
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami shores village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795,2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if
^x
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of '
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractoi is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNO LEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature: _ /"�� —
Owner
State of Florida
County of Miami -Dade
The forego' was acknowledge before me this 'A9) day of ��—, 20J
Ir.
� J By ll ! i k0 who is personally known to me or has produced
as identification. rMNESAWHEZTEJEDA
My COMMISSION i FF 952838
'_' April 30, 2020
�'
Notary::4 EXPIRES: Bonded Tliru Notary Put(Ic UederwrAen
SEAL:
u � ,
C' 6anar Refri & VeWation Contractors
,Aa Card 9. gerafiar
4120 HAN AVENUE I MU, FL 33133' 1305S25A501
STALE UC # C!I M607
January 25, 2019
State of: Florida
County of: Broward.
Before me this day personally appeared who, who, being duly sworn,
deposes and says:
That He will be the only one person working on the Project Located at:
Co ra r Signature
Sworn to (or Affirmed)
�and
� Subscribed before me this 2J� day of �Q� V� 2019,
By J- /O,VEL tLi �T"/ —I-0
Personally Know:
Or Produced Identification:
Type of Identification produced:
IVONNE SANCHEZ TEJEDA
�. MY COMMISSION M FF 952838
EXPIRES: April 30, 2020
Wed Tliru Notary Public Underwriter,
Print, Type or Stamp Name of Notary